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�r� N o. 0139 EH P. 1;NUMBER <br /> INN DA SAN JOAQUIN COUNTY <br /> I'm ENVIRONMENTAL HEALTH DEPARTMENT <br /> I.� APR 0 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> i:-:NVIPONMEI`!i%1LI�IEALTi-?hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vI -S �. BUSINESS/AGENCY: �1 '� ✓i wh�'e <br /> ADDRESS: s 3 8- CITY/STATE/ZIP: <br /> PHONE (1): 138T__x309 PHONE (2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$13 E SFi'OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l DATE �- I <br /> Electronic Information: ❑ Llst❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. ,❑Unit. <br /> '2 <br /> G SC�f f i]Unit ' <br /> 5. <br /> G. p Unit 4 <br /> 7. <br /> $- ❑ Unit 5 <br /> 9. - <br /> P <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IANDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHIGLvve <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD rACILITY ❑DAIRY <br /> BOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL >*VASTEWATERTREATMENT PLANT <br /> ,HAZARDOUS WASTE/HAZARDOUS MATERIALS Q MOTELIHOTEL E]PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING �COMPLAINTIRESPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> ABLE <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILFOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not he accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist, An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. "BOXED AREA-EHD USE ONLY, <br /> r] Records provided by.Staff-PPR Comalete. Staff Name: <br /> Received Time=Apr. 9.=2015= 3:.1-A, No. 8496 oe,o,n4 <br />